What is the diagnosis for a childbearing age woman who develops weakness, giddiness, and imbalance after an argument with her husband, with normal investigations and improvement with supportive care?

Functional Neurological Disorder (Conversion Disorder)

The appropriate discharge diagnosis is Functional Neurological Disorder (FND), also known as Conversion Disorder, characterized by neurological symptoms (weakness, giddiness, imbalance) that develop in temporal association with psychological stressors (marital argument), with normal investigations and rapid improvement with supportive care. 1, 2

Diagnostic Criteria and Clinical Features

The diagnosis of FND is made based on positive clinical signs rather than simply ruling out organic disease. 1 Key diagnostic features in this case include:

• Temporal relationship: Symptoms began immediately following an identifiable psychological stressor (argument with husband) 1, 2
• Neurological symptoms: Weakness, giddiness (dizziness), and imbalance represent altered voluntary motor and sensory functions 3, 4
• Normal investigations: All medical workup is negative, excluding structural neurological or medical conditions 3, 5
• Rapid improvement: Resolution within 24 hours with supportive care alone is characteristic of FND 3
• Patient insight: The patient acknowledges the temporal connection between the stressor and symptom onset, which supports the diagnosis 1

Why This Diagnosis is Appropriate

FND represents a condition where neurological symptoms are not deliberately produced and arise from genuine neurological dysfunction at the level of neural networks, rather than structural brain lesions. 2 The diagnosis should be framed as a rule-in diagnosis based on positive clinical features, not merely exclusion of other conditions. 1

The presentation fits the classic pattern where bodily stress (in this case, acute emotional distress from marital conflict) triggers functional neurological symptoms. 4 This is particularly relevant in the postoperative or acute medical setting, where psychological stressors can manifest as neurological deficits. 4

Documentation Recommendations

The discharge summary should include:

• Primary diagnosis: Functional Neurological Disorder (or Conversion Disorder per DSM-5 terminology) 1, 2
• Specific symptoms: Document the exact neurological manifestations (weakness, dizziness, imbalance) 3
• Precipitating stressor: Note the temporal relationship to the marital argument 1, 4
• Exclusion of organic disease: Document that comprehensive evaluation ruled out structural neurological conditions 3, 5
• Clinical course: Emphasize the rapid improvement with supportive care 3

Critical Pitfalls to Avoid

Do not label this as "psychosomatic" or imply malingering, as FND represents genuine neurological dysfunction with identifiable neural network abnormalities on advanced neuroimaging. 2 The symptoms are real and not under voluntary control. 3

Do not delay diagnosis by ordering excessive investigations once initial workup is negative, as early recognition and appropriate treatment (physical therapy, psychotherapy) improve outcomes and reduce healthcare costs. 3

Do not dismiss the patient's symptoms or suggest they are "all in her head"—this approach damages the therapeutic relationship and delays recovery. 1, 2

Treatment Implications for Discharge Planning

The discharge plan should include:

• Multidisciplinary referrals: Arrange follow-up with both neurology (or primary care) and mental health services 2, 4
• Physical therapy: Recommend early physical therapy to address motor symptoms and prevent chronicity 3
• Psychotherapy: Cognitive-behavioral therapy or other evidence-based psychological interventions address underlying stressors 2
• Patient education: Explain that FND is a recognized medical condition with specific treatment approaches, not a psychiatric diagnosis of exclusion 1

The prognosis is generally favorable with early diagnosis and appropriate intervention, particularly when symptoms resolve rapidly as in this case. 3